﻿<?php include("adulte_top.php")?>
<p>		
	<label for="autonomie">Autonomie :</label><input type="checkbox" name="autonomie" id="autonomie" value="1"/>
	<label for="cardiopathie" class="c2">Cardiopathie :</label><input type="checkbox" name="cardiopathie" id="cardiopathie"/>
	<label for="suicidaire" class="c2">Tendance suicidaire :</label><input type="checkbox" name="suicidaire" id="suicidaire"/>
</p>
<p>
	<label for="signature">Signature autonome :</label><input type="checkbox" name="signature" id="signature"/>
	<label for="suit_traitement" class="c2">Suit traitement médical :</label><input type="checkbox" name="suit_traitement" id="suit_traitement"/>
	<label for="alcool" class="c2">Alcool autorisé :</label><input type="checkbox" name="alcool" id="alcool"/>
</p>
<p>
	<label for="sortie">Sortie :</label><input type="checkbox" name="sortie" id="sortie"/>
	<label for="soins_infirm" class="c2">Soins infirmiers :</label><input type="checkbox" name="soins_infirm" id="soins_infirm"/>
	<label for="baignade" class="c2">Baignade :</label><input type="checkbox" name="baignade" id="baignade"/>
</p>
<p>
	<label for="fugue">Fugue :</label><input type="checkbox" name="fugue" id="fugue"/>
	<label for="prend_seul_traitement" class="c2">Prend seul traitement :</label><input type="checkbox" name="prend_seul_traitement" id="prend_seul_traitement"/>
	<label for="rester_seul" class="c2">Rester seul lieu séjour :</label><input type="checkbox" name="rester_seul" id="rester_seul"/>
</p>
<p>
	<label for="epilepsie">Epilepsie :</label><input type="checkbox" name="epilepsie" id="epilepsie"/>
	<label for="fiche_suivi" class="c2">Fiche de suivi médical :</label><input type="checkbox" name="fiche_suivi" id="fiche_suivi"/>
	<label for="photos" class="c2">Photos :</label><input type="checkbox" name="photos" id="photos"/>
</p>
<p>
	<label for="enuresie">Enuresie :</label><input type="checkbox" name="enuresie" id="enuresie"/>
	<label for="contraception" class="c2">Suit contraception :</label><input type="checkbox" name="contraception" id="contraception"/>
	<label for="num_urgence" class="c2">Numéro urgence :</label><input type="checkbox" name="num_urgence" id="num_urgence"/>
</p>
<p>
	<label for="encopresie">Encopresie :</label><input type="checkbox" name="encopresie" id="encopresie"/>
	<label for="medecin" class="c2">Médecin :</label><input type="checkbox" name="medecin" id="medecin"/>
	<label for="hospitalisation" class="c2">Hospitalisation :</label><input type="checkbox" name="hospitalisation" id="hospitalisation"/>
</p>
<p>
	<label for="asthme">Asthme :</label><input type="checkbox" name="asthme" id="asthme"/>
	<label for="ordonnance" class="c2">Ordonnance :</label><input type="checkbox" name="ordonnance" id="ordonnance"/>
	<label for="changement" class="c2">Changement séjour :</label><input type="checkbox" name="changement" id="changement"/>
</p>
<p>
	<label for="agressif" >Comportement agressif :</label><input type="checkbox" name="agressif" id="agressif"class="espacement"/>
	<label for="signature_fiche" class="c2">Signature fiche :</label><input type="checkbox" name="signature_fiche" id="signature_fiche"/>
</p>
	<label style="width:50px;"for="couple">Couple :</label><input style="margin-right:50px;" type="checkbox" name="couple" id="couple"/>
	<label style="width:80px;" for="conjoint" class="c2">Conjoint :</label><input type="text" name="conjoint" id="conjoint" class="grand"/>


<!-- 
<div id="div_conjoint">
	<label for="conjoint">Conjoint</label>
	<input type="text" id="conjoint" name="conjoint" onload="hide(this);" class="grand"/>
</div>
 -->





<!-- =============================================================

 <table id="ad-tab_param">
	<tr><th>Paramètres disponibles<th></th>
	<tr><td>Autonomie<input class="ad-add_param" type="button" value=">" /></td></tr>
	<tr><td>Signature autonome<input class="ad-add_param" type="button" value=">" /></td></tr>
	<tr><td>Sortie<input class="ad-add_param" type="button" value=">" /></td></tr>
	<tr><td>Fugue<input class="ad-add_param" type="button" value=">" /></td></tr>
	<tr><td>Epilepsie<input class="ad-add_param" type="button" value=">" /></td></tr>
	<tr><td>Enuresie<input class="ad-add_param" type="button" value=">" /></td></tr>
	<tr><td>Encopresie<input class="ad-add_param" type="button" value=">" /></td></tr>
	<tr><td>Asthme<input class="ad-add_param" type="button" value=">" /></td></tr>
	<tr><td>Cardiopathie<input class="ad-add_param" type="button" value=">" /></td></tr>
	<tr><td>Suit traitement médical<input class="ad-add_param" type="button" value=">" /></td></tr>
	<tr><td>Soins infirmiers<input class="ad-add_param" type="button" value=">" /></td></tr>
	<tr><td>Prend seul traitement médical<input class="ad-add_param" type="button" value=">" /></td></tr>
	<tr><td>Fiche de suivi médical<input class="ad-add_param" type="button" value=">" /></td></tr>
	<tr><td>Suit contraception<input class="ad-add_param" type="button" value=">" /></td></tr>
	<tr><td>Médecin<input class="ad-add_param" type="button" value=">" /></td></tr>
	<tr><td>Ordonnance<input class="ad-add_param" type="button" value=">" /></td></tr>
	<tr><td>Comportement agressif<input class="ad-add_param" type="button" value=">" /></td></tr>
	<tr><td>Tendance suicidaire<input class="ad-add_param" type="button" value=">" /></td></tr>
	<tr><td>Alcool autorisé<input class="ad-add_param" type="button" value=">" /></td></tr>
	<tr><td>Baignade<input class="ad-add_param" type="button" value=">" /></td></tr>
	<tr><td>Rester seul lieu séjour<input class="ad-add_param" type="button" value=">" /></td></tr>
	<tr><td>Photos<input class="ad-add_param" type="button" value=">" /></td></tr>
	<tr><td>Numéro urgence<input class="ad-add_param" type="button" value=">" /></td></tr>
	<tr><td>Changement séjour<input class="ad-add_param" type="button" value=">" /></td></tr>
	<tr><td>Signature fiche<input class="ad-add_param" type="button" value=">" /></td></tr>
	<tr><td>Couple<input class="ad-add_param" type="button" value=">" /></td></tr>
</table>
	<!--<input type="text" id="combo_param"/>!-->
	<!-- <select size="1" id="combo_param" name="combo_param" onchange="add_param();" class="grand">	
		<option>Autonomie</option>
		<option>Signature autonome</option>
		<option>Sortie</option>
		<option>Fugue</option>
		<option>Epilepsie</option>
		<option>Enuresie</option>
		<option>Encopresie</option>
		<option>Asthme</option>
		<option>Cardiopathie</option>
		<option>Suit traitement médical</option>
		<option>Soins infirmiers</option>
		<option>Prend seul traitement médical</option>
		<option>Fiche de suivi médical</option>
		<option>Suit contraception</option>
		<option>Médecin</option>
		<option>Ordonnance</option>
		<option>Comportement agressif</option>
		<option>Tendance suicidaire</option>
		<option>Alcool autorisé</option>
		<option>Baignade</option>
		<option>Rester seul lieu séjour</option>
		<option>Photos</option>
		<option>Numéro urgence</option>
		<option>Hospitalisation</option>
		<option>Changement séjour</option>
		<option>Signature fiche</option>
		<option>Couple</option>
	 -->
<!-- 		<optgroup label="Santé">
			<option>Cardiopathie</option>
			<option>Suit traitement médical</option>
			<option>Soins infirmiers</option>
			<option>Tendance suicidaire</option>
		</optgroup>
		<optgroup label="Autonomie">
			<option>Autonomie</option>
			<option>Signature autonome</option>
		</optgroup>		
		<optgroup label="Autorisations">
			<option>Alcool autorisé</option>
			<option>Baignade</option>
			<option>Photos</option>
		</optgroup>					
		<optgroup label="Autres">
			<option>Couple</option>
			<option>Autres...</option>
		</optgroup> 
	</select>


<label for="parametres" class="c2">	Paramètres actifs</label><textarea id="parametres" name="parametres"></textarea> -->


